Therapy Unpluggedhttp://blogs.psychcentral.com/unplugged
A blog about psychotherapy and therapy, by Sonia Neale.Sun, 22 Sep 2013 03:34:59 +0000en-UShourly1TherapyUnpluggedhttps://feedburner.google.comBorderline Personality Disorder: Naked Therapyhttp://blogs.psychcentral.com/unplugged/2013/09/borderline-personality-disorder-naked-therapy/
http://blogs.psychcentral.com/unplugged/2013/09/borderline-personality-disorder-naked-therapy/#commentsSun, 22 Sep 2013 03:17:53 +0000http://blogs.psychcentral.com/unplugged/?p=1782When you go to your therapy session what do you wear and why do you wear it and what does it mean to you?

Many years ago I would spend a week deciding what to wear. Should I wear this skirt because it was bold and flowing or these jeans because they were tight and hugging – leather or lace, denim or Doc Martens? What stylish, stunning threads would be the right ones in order to illicit the response I wanted? It all depended on my intention – was it to entertain and seduce, defend and demand or gain hope and heal?

Years ago I used to dress according to the role I wanted her to play with me, whether it be best friend, favourite aunt, smart sister, emotionally devoid mother, or secret lover and I would spend an inordinate amount of time getting my clothes and hair just right to illicit as many compliments as possible. When I was more regressed and should have been wearing a onesie to therapy, she would always comment on my hair and I’d forgotten about that until she mentioned how nice my new hairstyle looked recently and the memories came flooding back. In the past she always appeared to have a special weakness for my long blonde hair, one that I used to exploit mercilessly for her attention and approval. I always gave her compliments the more sinister interpretation of a seduction scenario.

Whether a cigar is just a cigar depends if you have a psychoanalytic bent or a cognitive-behavioural one. I finally realised that I had a therapist who prefers to stay in the present moment and lets you know that your hair looks nice today and that her compliments should be met with a simple “thank you.” Ever since that time ten years ago I have met similar compliments from other people with a similar response. Much of her firm, common sense therapy has sunk in over the years.

Since I stopped worrying about impressing her and more time asking her to challenge my belief systems, we spend a greater proportion of the time in authentic therapeutic connection. Our conversation has become real and genuine, warm and vulnerable – on both sides. It is what happens on the inside with therapy not what you wear on the outside. The intimate connection happens when you let that hard shell soften because the therapist wants to connect with your inner beauty and not your fashion sense. Clothes can be the barrier you unconsciously choose to protect yourself from hurt and harm when sharing your dark and dangerous past.

Even Freud in his quest for answers to turning neurotic misery into everyday unhappiness failed to realise that what we wear matters and can be an implicit coping/defence mechanism, along with splitting, projection and regression. Do we wear low cut lacy tops to seduce our therapists because we are afraid to let them see the raw viscera of our broken hearts, the naked, vulnerable self that was once so badly damaged? What lies beneath the surface of what Victoria’s Secret covers up is far more important to the curious inquiring therapist.

I do however, notice everything my therapist wears, which is usually baggy, shapeless, black and flowing garments with long strands of pearls, mismatching rings and bracelets. It has always puzzled me because from the back she appears to have a dynamite figure, pretty much the same one she would have had at 18, so she is not covering up issues and secrets between rolls of fat. She eats well and exercises regularly, yet chooses not to show her svelte figure (stunning for her sixth decade) off during business hours. Does she do this so her clients do not know who she is really is, so that they have more of a chance to express who they are? This dramatic attire appears to be de rigueur for the elderly, aging middle-class, wise-witch old-crone therapists who are finally comfortable with who they are. Black is her favourite colour. I sit on a long black couch surrounded by a seething tsunami of black scatter cushions, but her therapy is many shades of cool, calm and collected grey.

In summer off comes the shoes and she sits cross legged in the chair, and so do I. Our mirroring body language connects us at a more intimate level which occurs when I am not fixated on how attractive and pretty I need to appear in front of her. It’s easier to cry when you are not worrying about whether your mascara will run. Cortisol and adrenaline levels rise during therapy so scratching my forehead and cheeks is easier without fear of spoiling my foundation. I constantly play with my hair scrunching my fingers through it, pulling the strands from side to side in order to emphasise a point or to elicit the same hair-pulling and lock-playing transference from her – which ALWAYS happens.

No matter how we wear our hair or dress to impress there is always that ultimate defining moment in the therapy hour where we unwittingly, accidentally expose our deeply protected secrets and realise we are not wearing Gucci or Prada but The Emperor’s New Clothes rendering us raw, naked and vulnerable – and that is where the real therapy begins.

]]>http://blogs.psychcentral.com/unplugged/2013/09/borderline-personality-disorder-naked-therapy/feed/0Borderline Personality Disorder: Healing in Balihttp://blogs.psychcentral.com/unplugged/2013/09/borderline-personality-disorder-healing-in-bali/
http://blogs.psychcentral.com/unplugged/2013/09/borderline-personality-disorder-healing-in-bali/#commentsFri, 13 Sep 2013 03:46:15 +0000http://blogs.psychcentral.com/unplugged/?p=1774The difference between my young Borderline self and my older, somewhat wiser Borderline self is that I may still have the same intense feelings of rage, paranoia and injustice, but I now sit in those feelings and try to discover what they mean to me and channel them into a different, more positive direction. Instead of hating civilisation and its discontents I embrace the suffering, look inward and transform it into a learning opportunity for personal and spiritual growth. Part of that was learning to love what I already had instead of seeking out what didn’t belong to me and never would. The Buddha said, “Suffering is inevitable.” And it is – sometimes. It is what we do with that suffering that counts. I had to learn to lie down beside the Borderline bull, embracing her lacerating horns at a level we were both comfortable with.

After fifty years of eating disorders, lap bands, a small bowel obstruction, kidney cancer, malnutrition, metabolic syndrome and diabetes type 2, I was further diagnosed with a lump on my ovaries in August 2012. So I went to see my disease-free, de-toxed, slim, fit, healthy, yoga-inspired, meditative, free-range, organic, body-centred clinical psychologist who advised to me to do what she had been advising me to do for the past 17 years. Look after myself, be kind to myself, be gentle with myself and start to eat and exercise accordingly. What would you know about life? I thought, as I threw my last sugar binge in her outdoor bin before taking off on holiday with my husband.

Bali for me is usually one long, eating/drinking self-indulgent binge punctuated with cheap shopping sprees in and around Kuta – buying clothes I never wear and items I would sneer at back in Australia. This time we stayed at Lovina Beach and Ubud and I made the epiphanous decision to eat organic vegetarian, drink detox blends and spend as much time as possible being mindful at the Yoga Barn. I also relished the idea of torturing myself by hiking 500m almost vertically down (and back up again) to see the spectacular Munduk falls, as well as trekking through the Balinese National Park before embarking on a canoe trip across a mountain lake. Apparently I had not punished myself enough because later on we walked 5km through stunningly green rice paddies under the blazing Balinese sun to digitally capture some fluorescent-blue Papillon butterflies, blood-red mayflies, friendly but boringly beige frogs and the many indigenous birds whose fleetingly quick movements made me feel as though they were suffering from some form of avian ADHD.

I bought no commercial goods in Bali but came home with a replenished body, a renewed spirituality, a rediscovered soul and a magnificent collection of nature photos David Attenborough would be proud to own. Our Ubud accommodation overlooked 180 degrees of rice paddy fields where I captured this image of a Java Pond Heron who had just caught a huge, hapless frog in its mouth. There was much spiritual meaning in this photo for me. Some days we are the heron and other days we are the frog.

I had come back from Bali with much less internal baggage than I had taken because, still detoxing and exercising a month later, it was discovered my ovarian lump had disappeared. As well, much mindfulness, meditation and mung-beans had smoothed and refined the sharp horns of the Borderline bull and were now gently but firmly nudging me along the right path rather than endlessly stabbing with furious intent along the wrong one. That was a clear defining sign from the Universe that I had been given a second chance at life.

I fully believe in the mind/brain/body connection. I believe that what we put into our bodies affects our feelings, and this affects how we process our thoughts and all are intimately linked and entwined to our particular behaviour and make us who we are. Clean living equals clean thoughts or at least the ability to process them in a different more thoughtful, reflective and uncluttered manner. I learned to separate me from the rest of the world. I learned that I still have the same old problems after I have eaten, drunk, drugged or smoked in my futile attempts to smother the enduring shame of unspeakable, unbearable pain of existing in a world that constantly misunderstood me. Those days I was definitely the frog.

I started to use the words self-responsibility and empowerment and learned to apply them to my life. When I pried into her personal life, my therapist gently pointed out that she was very angry with me without raising her voice. This was an entirely new experience for me; I was far more used to a violent vocal reaction which effectively suppressed all forms of further communication on the matter. So I punished her with fifteen minutes of the best silent treatment I could dish out all the while fantasising about Revenge by Suicide. To me what I had done was not that bad (I thought she was being far too touchy and sensitive) but because my normal behaviour is another person’s abnormal, I needed to learn what sort of behaviour was socially acceptable to others so I could “fit in” – whatever that meant.

So as well as eating properly and exercising regularly, I was now learning how to regulate my emotions and tolerate distress without self-destructing and threatening suicide. I was to learn that lesson over and over and over again before it sunk in. I pushed my trusted therapist to the razor-edged abyss of her genteel anger where she saw perhaps abandoning me was the only way to reduce her own considerable stress tolerance levels. However, years ago she had made a promise never to abandon me, even though I made every attempt I could to make her throw me out of her professional life. I wanted to turn her life-long promise into my self-fulfilling prophesy. Her compassionate loving/kindness was driving me insane.

There must be easier ways to earn a living than being a DBT therapist. Not that she is one. I was assigned to her 17 years previously in a public mental health facility and I followed her into private practice. I used to think she was an Ice Queen, a Frigid Wicked Witch of the World of Therapy and paradoxically (because we Borderlines LOVE contradiction) fell deeply in transference with her. There is also an authentic bond between us that is part nostalgia, part business transaction, part mentorship, part symbiosis and mostly mother/daughter role-playing. Slowly I am starting to see her point of view. This can only happen with all-encompassing trust, respect and honour.

Being Borderline means that my logical, rational cortex goes off-line under severe stress and my immature, unplugged, raw and naked amygdala takes over like a black, seething, swirling vortex where the perfect storm of rage, paranoia and suicide-ideation collide. When my therapist went on holiday or away for the weekend, I learned to send her a polite email telling her to have a wonderful relaxing time instead of decompensating, booking into the nearest psychiatric facility and threatening to self-destruct. Those were the days I firmly embraced the heron.

I once had an adverse life event, picked up my 17 year old son from school, went to the local shops and had a road rage incident of such epic proportions I was prepared to die in a blaze of glory rather than move my car and let the other person pass. It was survival of the fittest and surrender was not an option. Charles Darwin might have applauded my efforts at self-preservation but everyone else involved was appalled.

That was the way I had lived my life – eat or be eaten. I’d lost my husband’s family, many employment opportunities and plenty of friends along the way. But I consoled myself thinking it was everyone else’s fault and nothing whatsoever to do with my repeated behavioural patterns.

My psychologist and I worked on many issues and it was her tough loving/kindness on a harsh family experience that finally permeated and infused my essential being. It was this feeling that shifted and cracked the Teutonic plate of self-hatred inside of me, something that was toxic, concrete, rigid, inflexible and unmoving and from the shattered remains arose an expanding, ethereal and cloud-like softness that had the feeling of self-love, self-forgiveness and self-acceptance. I had never felt more vulnerable, exhausted, uplifted and transformed all at the same time. It was a harrowing experience not unlike passing through the fires of hell and experiencing rebirth on the other side.

Peeling off the placental shawl and cutting through my own umbilical cord that had attached my whiny-self to my long-suffering therapist, I noticed that my old destructive addictions had given way to new, rich oxygenated life-giving ones. I am now addicted to good wholesome food, great health and much well-being. My husband and I like getting up at 5am and going for long walks in the bush, jogging at the gym, walking on the beach, and hiking up mountains. We dusted off our bikes and permanently traumatised our two teenage boys by purchasing matching bike-lycra and think nothing of riding 40km before breakfast. I now have stable employment and good relationships. I have lost 30kgs in six months and gained new vitality of body, mind and spirit.

I embrace Buddhism and being rather than destructive thinking and doing. I have learned to relax and live and let live. Suffering is not as inevitable as the Buddha made out. One can choose to suffer or one can embrace an imperfect world, let go of what is not necessary, and in the wise words of my sometimes devalued/mostly idealised therapist, “Take the bull by the horns and rejoin the rest of the world.”

Picture: Sonia Neale Bali 2012

]]>http://blogs.psychcentral.com/unplugged/2013/09/borderline-personality-disorder-healing-in-bali/feed/7Support Groups for People Diagnosed with BPDhttp://blogs.psychcentral.com/unplugged/2013/09/support-groups-for-people-diagnosed-with-bpd/
http://blogs.psychcentral.com/unplugged/2013/09/support-groups-for-people-diagnosed-with-bpd/#commentsFri, 13 Sep 2013 02:04:02 +0000http://blogs.psychcentral.com/unplugged/?p=1765
It’s been a long time since my last blog because I felt I had run out of things to say about BPD. However, since working in peer support work for the past year with a caseload that comprises of 75% women with BPD, I thought it prudent to resurrect my blog because I now have lots more to say both now and in subsequent blogs and I also need your valuable input for something I feel is incredibly exciting.

In Western Australia, we have no non-clinical psychologist run Dialectical Behaviour Therapy (DBT) services for BPD sufferers. We do have three teams in the metropolitan area of Perth run by fantastic, dedicated clinical psychologists who are the only MH professionals able to deliver this service. This is not nearly enough though. Only a small percentage of people can get help in this public sector which means they don’t have to pay. Medicare-refunded therapy (mostly with a considerable gap payment) is six sessions per year, an extra four if there are exceptional circumstances. Seeing as many people with BPD are on disability pensions, unemployed or under-employed, self-payment is not an option.

It is great that this is finally recognised but the reality is that long term clinical and non-clinical treatment options are simply not widely available in Western Australia. Through my role as a peer support worker I am hoping to start up a non-clinical self-help support and friendship group under the existing umbrella of government and non-government services. My long-term vision is to be trained and train others in DBT skills to set up other groups all over the Perth metropolitan and even rural areas. I have the backing of my team leader and manager of the organisation I work for.

My recovery from BPD has been a profound experience. I want to pass on that recovery process to the participants of the programme I work in and others who would otherwise be not able to access services. The group I am proposing to develop will be based on Dialectical Behaviour Therapy skills and strategies as well as individual strengths and goals.

In the two hour, once weekly group (consisting of six attendees and two facilitators consisting of one peer support worker and one professional) there will be an educational informational half and a caring and sharing half. It will be probably be obligatory for all attendees to have some previous DBT exposure mainly for risk management reasons. There will also be house rules and group norms and sharing guidelines and this will serve as an adjunct to clinical BPD services.

I am very excited about this and have the enthusiasm, support and help of like-minded others. So here is what I am asking you.

What would you like and not like to see in a self-help friendship group for people with BPD?
What BPD services are available or not available in your area, no matter what part of the world?
Were these services enough or not enough for you?

Is Google-stalking your therapist morally wrong, a self defeating masochistic exercise in futility, considered Borderline Personality Disordered behaviour or worse, or downright creepy, dangerous and illegal; or is it healthy curiosity and something everyone does but would not admit to – or perhaps all of the above?

I have received emails from my blog readers and heard personal anecdotes from people who have Facebook and Google-stalked their therapists and I have heard of therapists who have terminated clients once they found out the client had typed their name into the internet.

The golden rule is that you never put anything up on the internet you would not want your grandmother to read or the world to see on the front page of the daily newspaper. Google your own name every few weeks to see what other people have said about you and if it is derogatory either ask them to take it down or if they won’t then there are legal avenues you can take. I had to caution a friend’s daughter who had written some slanderous content about my motherhood skills on a parenting forum where someone had reviewed one of my books.

This is the internet age, the age of information sharing so expect to be Googled especially if you are a mental health professional. But while I might want to find out your professional history, qualifications, cost, location and perhaps some testimonials, there are self-imposing strict personal boundaries around this. If I start to type your children’s name into Facebook to find out personal information or to see family snaps of you then perhaps my curiosity belongs in a different dimension and I need to address the reasons why I want to seek this information out.

This sort of behaviour, like drugs, alcohol, smoking and food, can become very addictive very quickly. When you find out new information there can be a dopamine rush to the brain which acts as a reward and creates a deep neural pathway which leads to more of the same behaviour. Or it can work the other way and the information can be so distressing it can lead to self-harming behaviour. This is serious and non-judgemental, empathic and compassionate help is much needed.

I also believe, for the mental health professional, terminating the Google-stalking client is also about safety, security and risk management. I believe most therapists would want to find out the reasons why their client finds someone else’s life more fascinating than their own, but management can see things differently. Questions to ask is what is it that is lacking in their life that they want to spend inordinate amounts of time in a dark room in front of a pixellated screen in order find proof of life of someone else’s happy existence? Perhaps it could be a golden opportunity to address the lack of substance in the client’s life and boost and enhance their daily activity to a level where Google stalking no longer seems an attractive proposition.

However, as a therapist this can be very disconcerting at least and downright scary at worst. But if you do find out about this, would you be curious and ask the client what this meant for her/him or would you automatically terminate the client out of a sense of compromised personal safety? Also are you sure your personal safety is actually compromised? Does it depend on the functioning and insight level of the particular client? Would you allow this behaviour in some clients and not in others?

I am a Google-stalker and I have been Google-stalked. As an author who has appeared regularly on radio and in print and once on TV I have had people I work with tell me I have written two books, or been on radio or even that I write a blog for Psych Central. That is not creepy for me; I enjoy hearing that and feel as though what I do is appreciated and loved.

So at what point for some does this change from acceptable to downright creepy? Pre the internet age no-one would come up to you at a party and say they did a Dun and Bradstreet on you? Yet people tell me they Googled my name. I have Googled my therapist over the years. She knows about this and we have discussed it. Anyone with transference issues is highly curious of how someone else lives, especially if you have that someone else up on a pedestal. I was always open with her and let her know what I had found. We discussed my need to do this until I got to the point where my own life was more interesting than hers. Had she not addressed my behaviour in that manner and terminated me I would not be in the good place I am now. I also learned in the process that she also was curious about other people’s lives.

It is very much context dependent. It is all about culture, existing zeitgeist and what is considered socially acceptable behaviour for the changing times. If you are a therapist and you have an open Facebook with 1097 “friends” and you post controversial opinions and update your status three times a day (yes there are therapists who do that) then you should accept that your clientele are going to be curious about the rest of your life. Or perhaps you are so private that your Facebook is on total lockdown and even your own mother could not find you. In other words you need to manage your Googleness and check on it regularly.

I have been in the public eye in the past and I now work in mental health and I have met many people who do not meet social norms in terms of acceptable behaviour (not all of them are clients or patients some belong to other organisations) but rarely do I feel scared or threatened or feel my security and privacy compromised.

It has been said also, in jest, that you have not made it in Hollywood unless you have a stalker (see Kevin Bacon episode of Will and Grace). Some therapists might be terrified that they are not being Google-stalked. Others might be upset that they are not even considered Googleworthy.

Curiosity did not kill the cat, curiosity made it most inquisitive about its own nine lives. Unlike felines, you only have one life so make the most of it.

Photos: Sonia Neale – Ubud, Bali 2012

]]>http://blogs.psychcentral.com/unplugged/2012/11/borderline-personality-disorder-google-stalking-your-therapist/feed/26Borderline Personality Disorder: Good Will Hugginghttp://blogs.psychcentral.com/unplugged/2012/08/borderline-personality-disorder-good-will-hugging/
http://blogs.psychcentral.com/unplugged/2012/08/borderline-personality-disorder-good-will-hugging/#commentsSat, 25 Aug 2012 05:47:31 +0000http://blogs.psychcentral.com/unplugged/?p=1712I was surprised to find “Good Will Hunting” on our DVD recorded movies list. Apparently my oldest son, Matt recorded it thinking it was about guns. A great movie, and it was the bit at the end that settled an eternal question for me. Matt Damon hugs Robin Williams and says: “Doesn’t this violate the doctor/patient relationship?” and Robin Williams replies, “Only if you grab my arse.”

So, let’s get to the bottom of this once and for all. If it is OK for therapeutic couples to hug, then here are some types of therapy room hugs that might be considered appropriate:

The Stealth Hug: This happened for me about eight years ago. I saw her in the corridor wearing a green jumper and a black pleated skirt and I made a snap decision, so when I got into the room, I launched myself at her. She was quite startled, but put her arms around me and hugged. That, by the way, is the only correct response when a client stealth hugs a therapist. Had she refused, my mortification factor would have been stratospheric and I would have had to leave immediately – never to come back again. When a therapist refuses a client’s stealth hug it can make the client feel contaminated at best and the embodiment of evil at worst.

The Lonely Hug: Touching someone is a very intimate gesture. It provides warmth and creates a surge of oxytocin, the attachment/love hormone. Lonely people are sometimes oxytocin/dopamine depleted and need lots of hugs rather than mind-altering medication doled out by dull, bored and indifferent psychiatrists. Lonely people are the ones you find in long-term therapy. Lonely people are lonely because they either have no friends or their relationships have soured over the years. Sometimes a hug from their therapist can save their life.

The Therapist Initiated Hug: This has happened a few times and I really feel good about this one. I feel validated and affirmed and for me it means I have achieved what I set out to achieve in therapy and this is kind of like a reward for good work done. There’s nothing like realizing your therapist thinks you are OK in a normal, non-stalker sense.

The Bear Hug: Sometimes I get so emotional when I hug people (not just my therapist) I can get a bit carried away and end up crushing the hug recipient. I am always mindful of this in therapy. It is generally considered good manners not to crush your therapist into a small ball.

The A-Frame Hug: This is a great one because you get all the intimacy without any genital contact. It is always a good idea to keep your hands above waist level as well.

The Cheek Hug: This happened once after a very emotional session. It was interesting to note that her cheek was as cool as her handshake had been a few weeks earlier. The coolness was incongruent with the hot emotional therapeutic tension hanging in the room. I recall once thinking she was an Ice Queen. However, her mannerisms are very warm and inviting.

The Epic Fail Hug: I once went to hug my therapist and stepped on her foot with my black boot. That was four years ago and I have only just stopped blushing. The other epic fail was when my handbag slipped off my shoulder and crashed into her hip. We’ve also done the head “dosey doe” dance as well. Do you hug to the left or the right? Does the left hand go around the shoulder and the other hand hover above the waist? It gets a bit complicated.

The Short Hug: This is a kind of pat-pat hug and a really good hug to have at the end of therapy. Short, sweet and simple with no lingering aftertaste regarding transference issues. It is in essence a non-hug.

The Long Hug: Sometimes you just want to stay there forever; however even I know that is not appropriate (my therapist’s favourite word). It just feels warm, soft, soothing, inviting and suspended in time. People with abandonment/rejection/attachment issues tend to sink into this sort of hug and want to merge into the body of the therapist. This is good and needs to be verbally explored. A good therapist will provide both cognitive and behavioural experiences regarding the meaning of the hug for the client (and the therapist as well).

The Kiss: Never a good idea, this is crossing boundaries in a huge, damaging way.

Sometimes, I catch myself having fierce arguments in my head with people I have never met, about situations that have not happened, followed by resolutions that are never satisfying. My headspace is cranky and irritable and there is no logical preceding incident; it is just where my head automatically ends up when let off the leash and wanders free range. I call this IBS – Irritable Borderline Syndrome.

Now, when I catch myself doing this, I redirect my thoughts into something else. I discovered I was doing this on the 45-minute journey to and from work. Without external noise distraction (my radio/CD broke) and only my thoughts to keep me company on the stop/start traffic jam journey to and from work, I was mentally irritable from plotting evil thoughts, arguing with my inner self and ruminating long before I reached my destination. My armpits and skin would itch with stress induced hormones and my bowels and intestines would cramp into knots.

My therapist once told me that traffic jams and traffic lights were wonderful opportunities to un-cramp, de-itch and meditate into a peaceful state of mind, because you literally have nothing else to do, so use that head-space wisely. Instead of picking fights with people who don’t exist (I can argue with a lamppost sometimes) I now redirect (with much effort sometimes) those thoughts to something pleasant.

Towards my destination, I drive through semi-rural country and there are many horses, sheep, cows, ducks and geese on the side of the road to keep me company.

Like my daily routine, my mind needs much structure and focus. Arguing with myself is counter-productive to where I want to be. I want to move to infinity and beyond. I want to think of ideas. I read recently that small minds think about people, average minds think about events and great minds think about ideas. So I now keep a notebook in my bag for any great, world-transforming ideas that might spring to mind when traffic starts to bottleneck in front of me.

Conflict resolution is necessary for the function and progress of the human race and internal conflict resolution is imperative if I am to arrive at my destination free from mental cramps and diarrhea. Part of the BPD syndrome involves living in the past, being unable to get past previous situations and having a different perspective from others about the same events. If direct focus on personal events is too scary, then I can fabricate alternative scenarios which have a distinct revenge theme.

But instead of rocketing down that rabbit-hole every time a car stops in front of me, I try to practice mindfulness and meditation and think about happy or neutral present-day issues without judgement or harshness. This involves practice because redirecting anger into constructive thoughts processes did not happen overnight with me.

Dialectical Behaviour Therapy, or as I like to call it, Diabolical Behaviour Therapy involves much mindfulness, interpersonal effectiveness (including with yourself), emotional regulation (keeping those mind demons at bay) and distress tolerance. Tolerating the distress of being in your own thoughts at traffic lights can be quite liberating.

I could have gone out and bought a new car radio/CD but I would have missed this golden opportunity for personal growth. The first few months were agony and I missed my favourite radio stations. I had it on my list of things to do, but never got around to it. Then I slowly and gradually started to enjoy the peace, learning to live in the unregulated air space that was my twisted and tortured mind.

Then I started to greatly look forward to the nothingness, the blankness that I could fill with wonderful new ideas.

This became my personal time to save the world from itself, free the Universe from mental illness, self-sabotage and self-destruction, but most of all, it was my time to chill out, to decelerate my racing brain, keep it in neutral, humming and clicking over, and even staying completely idle in a fast, tumultuous, ever changing world. It is good not to be continuously plugged into white noise, loud-mouthed shock jocks, talk back drama and national opinions just so you don’t have to think.

Staying unplugged and mindful can take you on a well-worn car journey to a destination you have never been to before because you didn’t know it existed.

Borderline Personality Disorder is not just about mental illness and emotional distress, it is also about social skills (or lack of them), empathy, manners, conflict resolution and self-care. Most children learn these vital social skills early on at pre and primary school where they observe other children’s behaviour, learn a “theory of mind” or how other children think and feel (mentalising) and experience compassion and empathy for others. These things come naturally to them.

But some children, through no fault of their own, are unable to learn and remain totally clueless about how to survive socially in the playground. These are the kids who suffer social neglect, rejection and abandonment. These are the children who need a step by step guide or a “recipe” on how to learn empathy, how to be a team player, how to get on with other children, negotiation skills, conflict resolution, the rough and tumble of give and take and sharing toys with grace and dignity.

These kids need to learn that when this happens, this is the correct response. I was not one of those naturally cluey children; I lived in social Siberia most of my school life and became a library refugee.

Here are five survival techniques desperately needed when suffering from BPD:

SOCIAL SKILLS
Some people with mental illness lack manners and social skills, and this is not their fault. While I have no personal evidence to back this up, I know that when you are barely surviving the environment, it is near impossible to pick up on social cues from other children that you are not conforming or cooperating and that your behaviour is socially unacceptable.

When this carries on into adulthood it means job losses, social exclusion, lack of friends and relationship difficulties. However, having a mental illness and having non-acceptable social skills are two different things. I have seen many badly behaved people not taking responsibility for their actions, blaming everyone but themselves, simply because they lack manners, dignity and basic social skills.

It is never too late to learn, it is never too late to be aware of your own role in your mood swings and emotional distress.

EMPATHY
There is much internet anecdotal evidence which correlates Borderline Personality Disorder with Asperger’s Spectrum Disorder. People with Autism (high functioning in the case of Asperger’s Spectrum Disorder) have a distinct lack of empathy and mentalisation ability due to their neural wiring. But empathy along with social skills can be taught recipe-style by a competent therapist.

If there is a BPD/Asperger’s Spectrum Disorder correlation then the lack of empathy Professor Simon Baron Cohen states is part of the BPD syndrome may instead be due to the Asperger’s factor. I would appreciate anyone reading this to enlighten me further with a scientific evidence based journal paper (if one exists).

MANNERS
Even people with BPD know how to say please and thank you. But in times of crisis and distress, manners can easily get forgotten. I know, I’ve displayed appalling manners when cognitively/emotionally challenged. Part of the process of getting well is remembering manners.

Even if you have to carry a sheet of paper around with correct responses to various social situations — and I have done this — then it is worth it. Once I learned to remember my manners and took responsibility for my lack of them at times, I started to get on with people, reduce my mental distress, avoid much conflict and start to feel like a regular member of the human race.

CONFLICT RESOLUTION
Two words in the English language that can avert national disasters, world wars, nuclear holocausts, unemployment, divorce and ripped up relationships, and they are “I’m sorry.” You could, if you wanted, add, “I made a mistake.” How empowering, how liberating those words are. Saying this means you are responsible, you have taken ownership of your words and actions. Then look at yourself and think, “Aha! That’s where I went wrong, next time I will do it differently.”

Also, use statements like: I feel…when you…because it makes me feel… According to Norman Cousins, wisdom consists of the anticipation of consequences.

SELF-CARE
When I get something right, like an apology or taking responsibility for something that didn’t go well, I reward myself with flowers, an ornament, a book or something to remind myself I got it right, helped someone, said something, avoided saying something, or added value to the office harmony.

Being a person with a BPD diagnosis, I gave up smoking and drinking, starting eating well and exercising regularly (80 percent of the time). I cannot stress enough that there is a poisonous connection between drugs, alcohol, smoking, eating unhealthy foods and mental irritability. The best gifts you can give yourself if you have a BPD diagnosis also includes routine, regular sleep and tuning into your sixth sense about how you feel internally. HALT if you feel that gut feeling. Are you Hungry, Angry, Lonely or Tired? HALT and sort yourself out. Sit down for five minutes and evaluate your inner self.

Social skills and mental illness are separate entities. Don’t blame yourself or beat yourself up on either count; learn what manners and social skills are. Become your own expert on yourself and watch yourself grow and mature emotionally.

I work in mental health and I have seen this and experienced it. It is a thing of beauty to behold.

Photo: Black Swan and Ducks – Sonia Neale 2011

]]>http://blogs.psychcentral.com/unplugged/2012/08/borderline-personality-disorder-social-survival-skills/feed/14Borderline Personality Disorder: Self-esteem vs Self Destructionhttp://blogs.psychcentral.com/unplugged/2012/07/borderline-personality-disorder-self-esteem-v-self-destruction/
http://blogs.psychcentral.com/unplugged/2012/07/borderline-personality-disorder-self-esteem-v-self-destruction/#commentsMon, 30 Jul 2012 11:10:56 +0000http://blogs.psychcentral.com/unplugged/?p=1654There is a saying in a self-help group I used to be in back in the eighties. When a “normal” person gets a flat tire, they call the Automobile Association. When someone with (what’s now known as BPD) gets a flat tire, they call the suicide hotline. There’s an awful lot of truth in that.

My goal recently has been to respond rather than react to what I perceive are excruciatingly provocative circumstances and situations. I want to think and act with grace and dignity, to deep breathe, turn around, walk away, move on, learn the lesson and get a life. This attitude has, in the past, kept me in relationships, out of the law courts, out of jail, out of psychiatric hospitals, in employment and in therapy (or life coaching as we are now doing).

No longer is my therapist my nurturing supporter, smothering me endlessly with loving/kindness, reassurances of never abandoning me and justifying my bad behaviour and lack of social skills as a result of my environment. We have a more pragmatic egalitarian relationship where I feel mentored, rather than mental.

Responding quickly and with social correctness to sudden galling and goading instances and happenings when newly symptom-free, means being switched on to mindfulness at all times; even – especially – when you are unprepared. Life is full of incidental learning curves and today was no exception.

I went to the loo (bathroom) before going into her office and on the wash basin was an expensive text book so I took it to her office and said perhaps we should call office management and pass it on. She told me in a very stern voice, which broached no disagreement whatsoever indeed, that it was all sorted, to take it back to the toilets and leave it there.

But…I started to argue. So she told me that people knew about this and the best course of action was to take them back down – now. But...I started to argue again. However, her icy glare penetrated my fierce resistance and indignation and with my armpits itching I said with a forced smile: oh well I’ll have to take another trip down the stairs then.

So I resentfully stamped down the stairs and left the book on the bench and by the time I got back, I had decided to let it go, move on and get down to life coaching.

We then processed what had happened. I asked her how did it feel when I started to argue and she said that she felt I took it well, acted with grace and dignity and even had a sense of humour about it. I said that I felt she was quite directive (because she said we were about to start therapy and she did not want to waste time), however, seeing as I had no emotional investment in the book, I chose to cooperative with the current prevailing winds.

I compliantly conformed with the situation rather than resisting and rowing. I had passed (with a high distinction) my own unexpected accidental learning curve without realising it until it was over. I responded rather than reacted. My external appearance was one of going with the flow. This is what has kept me in the same employment for the past eighteen months.

I do know that eighteen months ago I would have argued with her till I got my own way. We would then have had a magnificent row and I would have shouted at her, devalued her, called her all sorts of names and cast aspersions upon her therapeutic ability, secure in the knowledge she once said she would never abandon me. The added bonus would be that I would have had an audience. Her colleague was in another room with an open door, and I could have seriously embarrassed us both.

I would have then driven home (perhaps through a tree or a freeway pylon) or gone home and drank, smoked, drugged and overate and blamed her for everything (of course) taking no responsibility for my actions.

Then, as the evening progressed, I would have sent her the obligatory apology email crucifying myself. She in return would send a very nurturing, and supportive email expressing loving/kindness (and we’d be back to therapy and not life coaching) and she would reiterate that she would not abandon me – ever.

Her colleague would have understood and silently labelled me as a borderline personality disorder and sympathized and debriefed with her. I would send her more idealizing emails and probably a huge bunch of very expensive flowers. And then we would start the cycle over again. Not dissimilar to the dynamics of a very dysfunctional relationship where abuse and possibly domestic violence are involved.

To a casual observer, this was a simple non-report worthy event, yet it was a monumental life-changing phenomenon to me. This all gets recorded in my body and in my unconscious and builds up and compounds on my social skills, resilience and a theory of mind, so the next time when it happens, I will do the same thing because it will feel right and keep doing it until it becomes automatic and I don’t even have to think about it.

This is what other people have taken for granted all their life; the ability to mentalize, empathize and see life from another’s point of view, even – especially when they don’t agree with them.

It’s easily to flow down the river than to fight against the rising tide because you get to your destination a lot quicker, feel a lot less exhausted and you get to enjoy the view on the way down.

]]>http://blogs.psychcentral.com/unplugged/2012/07/borderline-personality-disorder-self-esteem-v-self-destruction/feed/2BPD: Narcissistic Injuries, Madness and Mindfulnesshttp://blogs.psychcentral.com/unplugged/2012/07/bpd-narcissistic-injuries-madness-and-mindfulness/
http://blogs.psychcentral.com/unplugged/2012/07/bpd-narcissistic-injuries-madness-and-mindfulness/#commentsSun, 08 Jul 2012 00:10:37 +0000http://blogs.psychcentral.com/unplugged/?p=1632When you suffer from Borderline Personality Disorder (or complex trauma) one person’s constructive criticism or negative response is another person’s life-threatening narcissistic injury. I received a narcissistic brain hemorrhage this week when my challenging and authoritative therapist decided it was not relevant to our therapy to watch a video link I had emailed her.

My borderline reaction went to DefCon One in less than a nanosecond and I thought my brain would implode.

To be fair to myself, my thoughts remained relatively mindful (she’s said no before for the same reasons and yet I continue to email her things; it could be said that an idiot does the same thing all the time and expects a different response. If that is the case, then I am that idiot) but my body was transported instantly back to the mid-seventies where school bullying and parental fighting had finely tuned my fight, flight or freeze response.

It’s total madness to live in a high alert, hyper-vigilant state where everyone who has an adverse opinion is the enemy, but instead of smashing a cup, a plate or the TV remote, I sat in one place without moving and fantasized about her waking up with a teddy bear and rabbit’s head on the pillow next to her (Godfather style) and screaming incoherently. Luckily I am familiar with this over-reaction and my mindfulness skills kick in almost immediately; I just needed to briefly indulge my favorite revenge plot for a few glorious seconds.

I even tried watching Desperate Housewives to take my mind off her email, but try as I might she bears an uncanny resemblance to Bree Van de Kamp, so that particular day watching the ladies on Wisteria Lane was like pouring petrol onto an already roaring fire. So I decided to go food shopping and my perfectly coiffed blow-dried hair (ready for a function that night) ended up a tangled sticky mess after an unexpected and surprisingly strong thunderstorm hit our suburb.

Because of my state of mind I should have had a seizure and collapsed, but I amazed myself by taking a deep breath – and getting over it (I didn’t make it to the function after all, but that is another story).

But I still was not over that damned email nor my Damned Desperate Therapist. By this time two and a half hours had elapsed since my narcissism needed an ambulance.

These types of semi-fatal injuries are invisible and I managed to hide it well, go about my afternoon without any family member suspecting I was a walking/talking aneurysm. So I decided to re-read the email to see if I had missed something crucial – and I had. I had only read the bit about it not being relevant to therapy but there was so much more that I had missed – or misinterpreted.

This is what happens when my head explodes into a black anaphylactic abyss where toxic neurotransmitters invade and overwhelm my pre-frontal cortex. I literally do not see the rest of the words; I only see the “golf club sentence” which does my head in. I still have that Chernobyl reaction, but now I respond rather than react. I switched on the Large Hadron Collider in my head and manufactured much mindfulness particles (and maybe even the random thunderstorm) out of nothing and let this dark matter wash over me without judgment or criticism (as best I could) and did not let that damned time machine crank itself back to the future where I get sucked into the black hole of the madness and mayhem of the mid-seventies.

I emailed her the next day, took responsibility for my actions (a humbling experience, “sucking it up” as some would say) and mentioned, amongst other things, that I would not send her any more videos for her to watch, and my narcissistic injury healed beautifully without any scar. She knew this; somehow with the words she used in her next email she KNEW what had happened the day before.

She’s like that, she gets me. She’s a witch sometimes but a good witch. And Teddy and Rabbit are safe again, smiling and carefree in the way that all teddies, rabbits and young children should be.

At my last therapy session my therapist turned into a savage rottweiler; baring her sharp teeth at me, picking me up by the scruff of my neck and shaking the living daylights out of me. The doggone woman deliberately picked a fight about nothing, provoked me into a snarling row, called me a liar and then threatened to sue me for slander.

Interpretation of unfolding events is always a personal perception. I have been seeing her again for some workplace issues that need resolving. I was having problems accepting constructive criticism from the top dog in my organization. I found I was getting deeply triggered when told I was not achieving what I was supposed to achieve in the way she wanted it achieved and I was getting my feathers ruffled in a big way, getting upset, huffy and resolving the issue by fleeing or freezing.

So when within five minutes of arriving, my barking mad therapist activated every button on my panel and almost blew us both up, I almost called her a bitch, walked out the door and planned on brooding, ruminating and plotting impotent revenge against her for the rest of my natural life. Talk about an idealizing transference killer.

I argued back, “why are you doing this to me? Why am I paying you (insert discounted fee here) for you to have this argument with me?” I went from zero to borderline in 30 seconds flat. I wanted to duck for cover. My therapy (and therapist) had turned rabid and gone to the dogs. I might have been reasonably calm on the surface but I was paddling furiously underneath the water in order to stay afloat, but she was like a dog with a bone and would not let go. I had to reach for my handbag before she explained the method in her madness.

In her version of events, in the dog eat dog world of workplace employment, I wasn’t understanding how crucial it was to be able to accept criticism. I wasn’t getting how important it is to understand that sometimes even people with diagnosed BPD have to “suck it up” when their Princess tiara gets knocked off their head. I wasn’t “getting” that I had made a mistake and I needed to learn that not only is it OK to make a mistake, but that it is expected of me; it is not whether I make the mistake that is important, it is how I handle the subsequent discussion of what went wrong.

This is what my therapist was trying to explain to me. Sometimes in order to treat a disorder with a high emotional arousal component one has to tap into those high arousal emotions in order to correct erroneous thinking and belief systems. She also praised me for staying in the moment and processing it. It was tough love and her bite was worse than her bark this time because she cared. Talk about a dog day afternoon.

So when I grabbed my bag to leave, she told me she had deliberately bailed me up with both front paws against the wall and manufactured the situation in order to evoke the implicit (unconscious) emotional system to see my reaction and told me that this is why I have difficulties at work and why she wants to do body-centred psychotherapy with me. She asked me why in the entire argument, had I not been curious as to her point of view. Talk about ducks and drakes. In other words, she was sick to death of chasing her own tail when it came to my therapy not progressing.

I was so thrilled. She doesn’t do body-centred psychotherapy with just anyone. You have to be at a certain level of high functioning in order to do so, otherwise she could unleash the “Regan” (Linda Blair from the Exorcist) within. My therapist is an Exorcist, but more of a Joanne Woodward than Max von Sydow. In fact she is the sort of person who would hold an umbrella over a duck to protect it from the rain.

I was able to see what she did clearly and precisely and understood perfectly her body-centred experiment. Last time this happened I suffered the “freeze” syndrome where I sat for 15 minutes without moving and barely breathing. This time I was able to get back into my body and viscerally understand how it works under intense implicit evocation. It was so intense that I cried a few minutes later and after that it was water off a duck’s back.

I discovered (in this argument) I was reacting to the past not the present. Her provocation story involved a predator and a prey and I was reacting as a victim to the victim in her story. I was sticking up for the underdog, which of course was me. And this is how I react to people, including my family, children and husband, when even the slightest criticism has occurred.

Since then I’ve spent time being mindfully alert to how my body responds to criticism and changing how I choose to react. My body is still highly activated; the trauma of the past is locked away inside as it is with most people who are diagnosed with complex trauma disorder or borderline personality disorder. It is up to me to stick with what my therapist is trying to say to me in the nicest way possible so I don’t slink out of the door with my tail between my legs.

We have agreed to throw down our gauntlets into the arena and get down, like a pair of dirty dogs for some bare knuckled fighting. Validation and nurturing has been put to one side because as she said, if I don’t learn how to take criticism, my beloved job will be in danger. By this stage both our tails were wagging.

Even when I think I can take criticism I know it takes a huge toll on my physical health. Teaching me to accept criticism, to embrace it and even welcome it and remain centered with my tiara still sitting high on my head, rather than strangling me is where I want to be. My therapist now has me on a very short leash.

Perceptions of events differ from person to person. We all know of car accident witnesses who all have different accounts of what happened. I could have picked up my bag, told her to “get ducked” and walked out. I choose to accept her unorthodox method of therapy. I am paying her a ridiculous sum so she can make me feel like a roast duck, yet the lesson she gave me and the one before are priceless in terms of experientiality, safety, trust and loving kindness. She was in total control of what went on in that room; she is, in most ways, my guide dog.

If a man’s best friend is his dog, then a client’s best friend is her/his therapist.